What will the move to the RHPA mean for Ontario NDs?
Overall Goals and Approach of the RHPA
The goal of the RHPA is to ensure safe and effective health care by promoting self-regulating health professions. The RHPA promotes self-government of each profession by having a majority of members on each College Council from the profession, with the remainder usually being public members appointed by the provincial government. The RHPA provides the regulatory College of each profession with a broad framework of provincial government objectives for establishing and promoting the public interest.
Regulatory Colleges
There are currently 21 regulatory colleges for professions regulated by the RHPA, and legislation has now been passed to establish an additional 5 regulated professions, including naturopathic medicine, homeopathy and traditional Chinese medicine.
The primary focus of the colleges is the public interest. Colleges do not represent the profession, which is the role of the professional associations. In the broadest sense, the public interest is considered to be protecting the public from harm, promoting high quality care and making regulated health professions accountable to the public. While regulatory colleges and professional associations have different roles, there are many common interests, and the ability to collaborate is usually viewed as essential.
The regulatory colleges promote the public interest by developing and maintaining standards of practice for the profession through regulations and policies and by collaborating with professional associations to promote quality care. Where a practitioner is found to be outside of the standards of practice or has engaged in misconduct, the college has the ability to reprimand or prevent that member from practicing.
The normal activities of a regulatory college include:
- Member registration (including determining eligibility to practice);
- Education requirements;
- Complaints and investigations;
- Discipline;
- Quality assurance (which can include auditing the practice of members); and
- Patient relations.
Key Elements of the RHPA
For each of the regulated professions, the RHPA establishes a scope of practice, the controlled acts (if any), and title protection.The RHPA also establishes the harm clause which is intended to prevent non-health care professionals, or professionals acting outside their scope even without performing any of the controlled acts, from treating or advising people about their health when it is foreseeable that serious harm may result.
Scope of Practice
The scope of practice statement provides three types of information about a regulated profession: in broad terms what the profession does, the methods they use, and the purpose of the treatments. Under the RHPA, scopes of practice for a regulated profession are not exclusive and may overlap with other regulated professions. With overlapping scopes, the public has more choice about which kind of practitioner they want to see for the health care they are seeking.Controlled Acts
Under the RHPA, there are thirteen controlled acts which only members of a regulated health profession may perform. The controlled acts (if any) are assigned to each profession by their profession-specific legislation.The controlled acts are established in detail in the RHPA. In brief, they are:
- Communicating a diagnosis;
- Performing a procedure below the dermis, etc.;
- Setting or casting a fracture or dislocation;
- Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust;
- Administering a substance by injection or inhalation;
- Putting an instrument, hand or finger into openings in the body;
- Applying or ordering the application of a prescribed form of energy;;;
- Prescribing, dispensing, selling or compounding a drug;
- Prescribing or dispensing eye glasses, etc.;
- Prescribing a hearing aid;
- Fitting or dispensing dental devices, etc.;
- Managing labour or conducing a birth; and
- Allergy challenge testing that could result in a significant allergic response.
The Health Systems Improvement Act has proposed a fourteenth controlled act – psychotherapy. As well, the Traditional Chinese Medicine Act has clarified that acupuncture is part of the controlled act of a procedure below the dermis.
Provincial regulations and the regulatory colleges can establish
additional requirements for the controlled acts for each profession.
The RHPA also creates the potential for a member to delegate a
controlled act, and some other exceptions.
